Blood Bank Research Articles

Enhancing clinical insight: Implementing validated questionnaires for comprehensive assessment of clinician expertise in transfusion medicine practices

BackgroundBlood transfusion is a cornerstone of modern healthcare, pivotal in saving countless lives annually. However, inadequate knowledge among healthcare providers can lead to serious complications. Despite the availability of assessment tools like the Biomedical Excellence for Safer Transfusion (BEST) test, there is a need for indigenous-validated questionnaires to address knowledge gaps effectively. This study aimed to evaluate bedside transfusion medicine knowledge among clinical residents using a validated questionnaire, focusing on knowledge gaps. Study design and methodsA cross-sectional study was conducted at a tertiary care referral center in Northern India. The questionnaire, developed based on national and international transfusion guidelines, was validated by an expert panel, and administered to 245 clinical residents. The questionnaire covered six domains related to transfusion medicine: blood component storage, blood bank procedures, transfusion-transmitted infections, administration of blood components, transfusion reactions, and transfusion practices. ResultsThe study revealed varying levels of knowledge across specialties and residency years. Overall, residents scored 61 % in transfusion medicine knowledge, with Pediatrics residents demonstrating the highest scores. The incremental increase in knowledge from first to third-year residents underscores the value of continuous, experience-based learning throughout the residency period. DiscussionStudy highlights significant knowledge gaps in bedside transfusion practices among clinical residents, emphasizing the need for structured educational interventions. Tailored programs, integrated into undergraduate and postgraduate curricula, are essential to improve transfusion safety and patient outcomes. Addressing these gaps can lead to better bedside transfusion practices, reducing risks and improving the quality of patient care.

A systematic review of indications when and how a military walking blood bank could bridge blood product unavailability.

Blood supply problems in remote areas are well known. To overcome this shortage, many countries have developed innovative walking blood bank (WBB) protocols. However, no common standards have yet been set for their use and common actions. Given that these procedures involve a certain risk, it would be interesting to analyse the activating criteria that lead to using this unusual protocol. Thus, this review aimed to identify indications for a WBB and the common risk mitigation measures. This PRISMA-compliant review only included studies published from 1985 to 25th of January 2023 that describe adult male military casualties requiring blood transfused locally using a walking blood transfusion protocol. All relevant data (i.e., activation and contextual factors and risk mitigation measures) were tabulated to retrieve information from the selected military studies. Our results indicated that activation criteria were homogeneous across the 12 reviewed studies. Whole blood was collected from a WBB when there was a shortage of blood products and when platelets were needed. In the literature reviewed, the main risks associated with such a protocol, namely hemolytic adverse events and transfusion transmitted diseases, are mitigated by the use of typing and screening measures if they are reported. However, there is less consistency in the implementation of those risk mitigation measures. This unusual protocol needs to be integrated into the medical support plan until conventional transfusion support can take over, and should include on-site blood collection from a donor, whether a WBB or an emergency donor panel. The benefits of such a protocol outweigh the risks in a life-threatening situation, especially since these risks can be anticipated and minimised by planning to pre-screen all potential donors before their deployment. Finally, educating and training the staff who must implement this unusual procedure can also improve the safety and survival rate of future patients.

Age above all: The impact of storage duration in mice resuscitated with whole blood or packed red blood cells and plasma in a hemorrhagic shock model

BackgroundThe use of whole blood compared with a balanced ratio of components in trauma resuscitation remains an area of ongoing investigation. One factor that may affect outcomes is the age of the blood product transfused. We used a murine model of blood banking and hemorrhagic shock resuscitation to compare the effect of storage duration in whole blood and packed red blood cells on the recipient inflammatory response. MethodsMurine whole blood or packed red blood cells were evaluated for the red blood cells storage lesion up to 14 days. Mice underwent hemorrhagic shock followed by resuscitation with whole blood or packed red blood cells combined with equal volume of thawed plasma (1:1) stored for 1, 7, or 14 days. Serum and lung cytokine/chemokine levels were measured and leukocyte infiltration determined via immunohistochemistry. ResultsBoth whole blood and packed red blood cells develop a blood storage lesion. Four hours after resuscitation, mice resuscitated with either day 14 whole blood or 1:1 demonstrated increased inflammatory cytokines and chemokines with similar findings within lung tissue compared with mice resuscitated with whole blood and 1:1 products stored for 1 or 7 days. ConclusionsResuscitation with murine packed red blood cells or whole blood stored for 14 days produces a pronounced recipient inflammatory response compared with those units stored for lesser durations. Given the shorter storage duration of human whole blood to packed RBCs, resuscitation with whole blood within current storage limits may represent an advantageous resuscitation strategy compared with older packed red blood cells.

Categorization of the Inevitable Causes of Blood and Components Wastage Detected in South Indian Urban Blood Centre

Background: Since there is no artificial substitute for human blood, it plays a vital role in the patient management in this era of modern medicine. Therefore the donated blood from a healthy donor is precious and must not be wasted without proper utilization. Blood wastage is a universal phenomenon which needs a careful approach with strict guidelines. The study aims at categorizing the various inevitable causes of wastage with an attempt to determine ways of preventing the loss due to non-utilization. Materials and Methods: A retrospective – cross sectional study was conducted in a newly started Stand-alone Blood Centre in South Indian Urban city between June, 2022 and June 2024.All the components including Whole Blood (WB), Packed Red Blood Cell Concentrate (PRBC), Platelet concentrate (PC) and Fresh Frozen Plasma (FFP) were included in the study. The reasons for blood and component wastage was noted down from the various Registers of the Blood Centre and all the data was analyzed using Microsoft Excel Spread Sheet. Results: A total of 2456 units of blood were collected. 5284 components were prepared from these which includes 42 units of Whole Blood, 2397 Packed Red Blood cells(PRBC), 2393 Fresh frozen Plasma(FFP), 452 Platelet Concentrate(PC).Overall discard rate was found to be 11.90%. PC discard rate was highest (49.34%) followed by WBU (19.04%), PRBC (13.01%) AND FFP (3.59%). The commonest cause for the discarding was expiry of the shelf life of blood bags (74.72%) followed by damaged bags (9.69%) and TTI’s (6.76%). Conclusion: Blood and its components wastage is an inevitable reality which needs to be approached as upmost priority. Zero wastage of blood and components may be targeted by recommendations like appropriate training of the blood bank staff, keeping negative group donors on reserve, strictly following FIFO policy while dispensing blood, whole blood unit collection may be minimized, encouraging Single Donor Platelets (SDP) by apheresis instead of Random Donor Platelets (RDP) preparation, Blood Utilization Committee to be made mandatory and permission for reciprocal sharing of blood components among blood banks.

Genetic engineering of transfusable platelets with mRNA-lipid nanoparticles is compatible with blood banking practices

AbstractPlatelets contribute to a variety of physiological processes, including inflammation, sepsis, and cancer. However, because of their primary role in hemostasis, platelet transfusions are largely restricted to managing thrombocytopenia and bleeding. One way to expand the utility of platelet transfusions would be to genetically engineer donor platelets with new or enhanced functions. We have previously shown that lipid nanoparticles containing mRNA (mRNA-LNP) can be used to genetically modify authentic platelets in a nonclinical crystalloid solution. Currently, platelets collected for transfusion are stored in plasma or in plasma supplemented with platelet additive solution (PAS) at supraphysiological concentrations at room temperature, or at 4°C if intended for use in acute hemorrhage. Here, we describe a new plasma-optimized mRNA-LNP for transfecting platelets directly in plasma and plasma supplemented with PAS that is scalable to physiological and supraphysiological platelet concentrations. Transfecting platelets in clinical solutions with mRNA-LNP does not affect aspects of in vitro physiology, and transfected platelets are storable. The compatibility of this transfection system with current clinical practices could enable future mRNA-LNP–based platelet products and cell therapies.

A novel high-performance rapid screening test for the detection of total HTLV-I and HTLV-II antibodies in HTLV-I/II infected patients

Rapid diagnosis of human T-cell lymphotropic virus (HTLV) type-I and -II infections are essential for timely and cost-effective disease interventions. MP Diagnostics ASSURE HTLV-I/II Rapid Test was developed for the rapid detection of anti-HTLV-I/II antibodies in patients’ serum, plasma, and whole blood specimens. ASSURE HTLV-I/II Rapid Test employed MP Biomedicals’ proprietary HTLV-I/II Trifusion recombinant antigen conjugated with gold nanoparticles and HTLV-I / HTLV-II recombinant antigens immobilized on the nitrocellulose membrane to detect total HTLV-I and HTLV-II antibodies. The overall performance of the ASSURE HTLV-I/II Rapid Test was found to be 99.42% sensitivity (95% Confidence Interval, 98.32–99.88%) and 100% specificity (95% Confidence Interval, 99.58–100.00%) in the tested clinical samples, including a total of 518 HTLV-I/II positive specimens (396 HTLV-I infection, 97 HTLV-II infection and 25 HTLV-I/II dual infection) and 872 HTLV negative clinical specimens consisting of 691 healthy donor samples, 116 potentially cross-reactive samples, and 65 samples with interfering substances. The ASSURE HTLV-I/II Rapid Test can effectively be deployed as a screening tool in any prevalence studies, blood banks or organ transplant centres.

Bioelectrical Insight: Correlation Cell Count and Electrical Impedance of Whole Blood throughout Storage with an Impedance Analyzer Methode

Blood, a vital tissue comprising blood cells within the plasma matrix, plays a crucial role in transporting oxygen, nutrients, and functional components throughout the body. Insufficient blood levels can lead to disorders or life-threatening conditions, necessitating blood transfusions for those experiencing deficiencies. Blood banks store blood products to meet transfusion needs, emphasizing safety, donor health, patient conditions, cross-matching accuracy, and storage quality. Examining stored blood indicates an individual's physiological response to environmental changes, with quantitative and qualitative changes visible through whole blood cell count and impedance parameters. Electrical impedance spectroscopy, which measures these biological properties, shows that although blood cell count remains stable over 35 days, impedance characteristics change significantly. Analysis of the Nyquist Zriil plot reveals a consistent decrease in Zriil values, indicating reduced extracellular resistance (Res) over time. These impedance changes reflect alterations in blood morphology, providing crucial insights into the quality of stored blood. In conclusion, electrical impedance spectroscopy effectively monitors stored blood quality, detecting significant changes in extracellular resistance over extended storage periods. These findings underscore the importance of regular monitoring and proper management of stored blood to ensure its safety and effectiveness for transfusions.

Comparative analysis of treponemal specific chemiluminescence test and rapid card test for screening of syphilis in blood donors – A tertiary center study

Abstract: BACKGROUND: Screening for transfusion-transmitted infections (TTIs) is an important step for the safety of blood transfusion. Major TTIs for which screening is done are hepatitis B surface antigen, antibody to hepatitis B virus, hepatitis C virus, human immunodeficiency virus, syphilis, and malaria. The aim of this study was to compare the diagnostic accuracy of treponemal-specific chemiluminescence test and rapid card test for the screening of syphilis by taking Treponema pallidum hemagglutination assay (TPHA) as a gold standard test. MATERIALS AND METHODS: This was a cross-sectional study. All the routine blood donors were screened according to the National Blood Transfusion Council guidelines. One hundred and twenty syphilis serology-positive samples were obtained either by rapid card test immunochromatographic test/chemiluminescence assay or both. These samples were further tested by TPHA (gold standard test). Statistical analysis was done using the Mcnemar test, DeLong et al. test, and Chi-square test P < 0.05 was considered statistically significant. RESULTS: The sensitivity and specificity of both chemiluminescence and rapid card test were comparable (P < 0.0001) and the diagnostic accuracy of chemiluminescence and rapid card test was 95.83% and 94.58%, respectively. CONCLUSION: Both chemiluminescence and rapid card tests show comparable performance, so it is concluded to use rapid card test as a reliable backup in remote areas, peripheral blood bank setup, and in emergency situations where timesaving is lifesaving.

A rare case of ABO grouping discrepancy due to probable blood group switching which presented as lost antigens detectable only with indigenous reagents in less sensitive platforms compared to highly sensitive automated platforms using non indigenous reagents

Abstract: Blood group switching in the form of loss or diminished expression of RBC antigens has been reported in malignancies and infections. Blood group antigens are present on the red cell surface. ABO blood group system is the most clinically significant system. Some cases can present as grouping discrepancy. Here we present a rare case of ABO grouping discrepancy due to probable blood group switching which presented as lost antigens detectable only with indigenous reagents in less sensitive platforms compared to highly sensitive automated platforms using non indigenous reagents. 66 year old female whose historic blood group was A Rh D positive with history of uneventful transfusion of 2 units of A Rh D positive packed red cell one and half years back now presented with mycoplasma pneumonia and acute pulmonary edema. On routine complete blood count testing her hemoglobin was 3.6 gm%, request send to blood bank for pretransfusion testing. Testing performed via conventional tube technique and ABO blood group discrepancy was noted with forward grouping turned to be A Rh D positive (positive reaction with anti A1 lectin) and on reverse grouping 3+ reactions was observed in both A and B cell giving a picture of O blood group. Blood grouping was performed in different platforms including fully automated, semi automated and manual using commercially available antisera and human plasma as a source of anti A, anti B antibodies for forward grouping. The antisera used in automated platforms are non indigenous and that for manual are indigenous. Discrepancy was noted (Forward A and Reverse O) in CTT with commercially available antisera and human plasma as reagents for forward grouping .The same discrepancy was noted with CAT in neutral card with commercially available antisera for manual grouping. But when grouping performed with Column Agglutination Technology using matrix grouping gel card the discrepancy was resolved reporting the blood group as O. For further confirmation we repeated the blood grouping in another fully automated platform, SPRCA Technology (Immucore NEOIRIS) and in that also no discrepancy noted giving a picture of O group. This patient probably had undergone a blood group switching from A to O by losing some but not all A epitopes and started anti A antibody production. Some A epitopes which were not lost had been picked up by the commercially available antisera intended for manual grouping. These antisera are indigenous in origin. Also when human plasma was used as source of antibodies the A epitopes which were not lost were detected. But when grouping was done with non-indigenous antisera in both manual and automatic platform the A epitopes were not detected. This case points towards the relevance of incorporating indigenous antisera in automated platforms.

Abstract 21: Feasibility of Harnessing Umbilical Cord Tissue for Alveolar Cleft Repair: A Collaboration between a Large Academic Institution and a Private Family Cord Blood Bank

Abstract 21: Feasibility of Harnessing Umbilical Cord Tissue for Alveolar Cleft Repair: A Collaboration between a Large Academic Institution and a Private Family Cord Blood Bank

Abstract 12: Cord Blood Banking, Technical and Clinical grade GMP- Development of Advanced Therapy Products as HLA-Homozygous iPSC-derived Cardiomyocytes

Abstract 12: Cord Blood Banking, Technical and Clinical grade GMP- Development of Advanced Therapy Products as HLA-Homozygous iPSC-derived Cardiomyocytes

Abstract 14: Contribution of US Public Cord Blood Banking to Improved Engraftment and Survival after Allogeneic Cord Blood Transplantation (CBT)

Abstract 14: Contribution of US Public Cord Blood Banking to Improved Engraftment and Survival after Allogeneic Cord Blood Transplantation (CBT)

Abstract 7: Influence of Long-term Storage of Cryopreserved Automated Volume-Reduced Cord Blood Units Until 20 Years: Analysis From Barcelona Cord Blood Bank, Spain.

Abstract 7: Influence of Long-term Storage of Cryopreserved Automated Volume-Reduced Cord Blood Units Until 20 Years: Analysis From Barcelona Cord Blood Bank, Spain.

Abstract 6: Value of a Multi-Regional Cord Blood Bank Program: Multiple Collection Centers to Select High-Quality Units for Transplantation

Abstract 6: Value of a Multi-Regional Cord Blood Bank Program: Multiple Collection Centers to Select High-Quality Units for Transplantation

Prevalence and factors associated with transfusion-transmissible infections (HIV, HBV, HCV and Syphilis) among blood donors in Gabon: Systematic review and meta-analysis.

Transfusion-transmissible infections (TTIs) remain a major public health problem in countries with limited resources, particularly in Gabon. Complete information on the prevalence in Gabon of the main TTIs among blood donors is still lacking in the national context. The purpose of this systematic review and meta-analysis was to determine the prevalence and factors associated with TTIs among blood donors in Gabon. This systematic review and meta-analysis was reported in accordance with the PRISMA 2020 guidelines. It was the result of data from several comprehensive studies published between 2014 and 2022, the purpose of which focused on the prevalence and factors associated with TTIs among blood donors in Gabon. The quality of the articles was assessed using the Joanna Briggs Institute critical appraisal checklist for studies reporting prevalence data. The overall prevalence of TTIs among blood donors was determined using the random effects model. Heterogeneity between studies was assessed using I2 statistics. Publication bias was assessed by visual inspection of the funnel plot and Egger's statistics. A total of 175,140 blood donors from the nine eligible studies were admitted to this study. The combined prevalence of HIV, HBV, HCV and syphilis obtained in the random effects model was 3.0%, 6.0%, 4.0% and 3.0%, respectively. Moreover, being a male blood donor and aged between 25 and 44 years was significantly associated with HBV infection and being a female blood donor and aged 35 years and over was significantly associated with HIV infection. Family or replacement blood donors had a high infection burden for all four TTIs of study. The overall prevalence of transfusion-transmissible infections remains high in the country's blood banks. Improving current prevention (selection criteria) and screening strategies may be necessary in a global approach.

Improving normothermic machine perfusion and blood transfusion through biocompatible blood silicification

The growing world population and increasing life expectancy are driving the need to improve the quality of blood transfusion, organ transplantation, and preservation. Here, to improve the ability of red blood cells (RBCs) for normothermic machine perfusion, a biocompatible blood silicification approach termed "shielding-augmenting RBC-in-nanoscale amorphous silica (SARNAS)" has been developed. The key to RBC surface engineering and structure augmentation is the precise control of the hydrolysis form of silicic acid to realize stabilization of RBC within conformal nanoscale silica-based exoskeletons. The formed silicified RBCs (Si-RBCs) maintain membrane/structural integrity, normal cellular functions (e.g., metabolism, oxygen-carrying capability), and enhance resistance to external stressors as well as tunable mechanical properties, resulting in nearly 100% RBC cryoprotection. In vivo experiments confirm their excellent biocompatibility. By shielding RBC surface antigens, the Si-RBCs provide universal blood compatibility, the ability for allogeneic mechanical perfusion, and more importantly, the possibility for cross-species transfusion. Being simple, reliable, and easily scalable, the SARNAS strategy holds great promise to revolutionize the use of engineered blood for future clinical applications.

Detection of HBV DNA by direct PCR protocol and Nested PCR protocol and comparing them in chronic patients and healthy carriers of Hepatitis B virus.

Hepatitis B virus is a major public health problem, and the outcome of infection depends on the effectiveness of the virus's interaction with the host, and in particular on the strength of the natural and conditioned response of humoral and cellular immunity. This study was conducted to assess the clinical status, genetic immunity and viral (viral) traits of Iraqi patients with chronic hepatitis B virus and healthy carriers of hepatitis B surface antigen, as well as to show the relationship between the immune status and the chronic condition of the disease. The study included (60) patients with chronic hepatitis B virus type (B) and (60) healthy hepatitis B surface antigen carriers who attended the Teaching Hospital for Gastrointestinal and Liver Diseases in Nasiriya City Al-Hussein Teaching Hospital, Thalassemia Center and the Central Blood Bank in Nasiriya Citysouthern of Iraq. for the period from the first period. From February 2022 until the end of February 2022, the average age of patients infected with chronic hepatitis B virus was 64.5 years, and the average age of healthy carriers of hepatitis B surface antigen was 35. 1 year, and the ratio of males to females was (12.2:) for chronic patients and (13.6:) for carriers of the disease. As for the deoxyribonucleic acid, it was (100%) in chronic patients and healthy carriers using the Nested type polymerase chain reaction, and at a rate of (30.0%) and (46.7%) in chronic patients and healthy carriers, respectively using the polymerase chain reaction technique. direct with a significant difference between the two interactions. The current results confirm that a nested PCR protocol to detect HBV DNA is a more sensitive way of detecting HBV in Iraq CHB patients and carriers. Recent advanced techniques such as nucleic acid assays, quantitative assays for viral load and RT-PCR for Iraqi viral hepatitis laboratories are recommended.

A review of maternal near miss events in a tertiary teaching hospital- A tool for improving quality of obstetric care in developing countries: A descriptive study

: In 2015, the United Nations Member States adopted the Sustainable Development Goals (SDGs), which include reducing the maternal mortality (MM) ratio by two-thirds by 2030. Maternal mortality rates are alarming, especially in low-income countries where 99% of all maternal deaths occurs. Maternal Near Miss event was described by the World Health Organization (WHO) as “A woman who is close to death survived a complication that occurred during pregnancy, delivery or up to 42 days of termination of pregnancy.” This concept was launched in the health system. Maternal near-miss audit was recognized as a useful tool to improve the quality of obstetric care. A descriptive study was conducted at PCMC’s Postgraduate Institute and YCM Hospital Pimpri Pune (Maharashtra) from 1st January 2020 to 30 June 2021. During the study period, Maternal Near miss (MNM) cases were identified as per WHO criteria for enrolment. This study reviewed near-miss cases with aim to study baseline assessment, to analyse cause and intervention to improve health cases.: Of total 9534 admissions, 130 mothers had severe maternal outcomes (114 maternal near-miss cases and 16 maternal deaths). 104(91.23%) MNM cases were between the ages of 20-35 years, 72.13% were from rural, 78(68.42%) were referred from health facilities.Seventy two(63.86%) were multigravida. Sixty Nine (60.53%) had hypertension in pregnancy followed by 62 (54.39%) had haemorrhage.: Our study concluded hypertension in pregnancy and haemorrhage are major causes of MNM cases. ICUs and blood banks play a pivotal role in the prevention of maternal mortality. Developing countries should aim to improve maternal health outcome by improving HDU/ICU facilities and blood bank to reduce maternal mortality.

Magnitude of Transfusion Transmissible Infections and Associated Factors Among Blood Donors at the Woliso Blood Bank, Oromia, Ethiopia: Across-Sectional Study

<i>Background: </i>Blood transfusion is an effective treatment for saving millions of lives, even though transfusion-transmissible infections are the major problem. The prevalence of transfusion-transmissible infections varies between different geographical populations. This study aims to assess the prevalence of transfusion-transmissible infections and associated factors among blood donors at Woliso Blood Bank, South West Shewa Zone, Oromia, Ethiopia. <i>Method: </i>An institutional-based cross-sectional study design was conducted. A structured and pre-tested questionnaire was used to collect data through a face-to-face interview. The data was entered in Epi Data version 3.1, and exported to STATA version 17.0 for data cleaning and analysis. A binary logistic regression analysis was performed to identify factors associated with outcome variables. Odd ratios along with the 95% confidence interval were used to present the finding and statistical significance was reported with a p-value of 0.05. <i>Results: </i>The overall prevalence of transfusion-transmissible infections was 9.5% (95% CI 6.3-12.9%). Participants without formal education [AOR=4.84; 95% CI= 1.09, 21.46], unprotected sexual intercourse with multiple partners [AOR=4.77; 95% CI= 1.38, 16.44], and participants with a lower frequency of blood donation [AOR=2.85; 95% CI: 1.16, 6.99] were significantly associated with transfusion transmissible infections. <i>Conclusions: </i>The prevalence of transfusion-transmissible infections was high in this study area. Educational level, unprotected sexual intercourse with more partners, and a number of blood donations were found to be independent predictors of transfusion-transmitted infections. Blood banks and regional health offices should work to mobilize the community and improve health promotion through prevention and control considering the associated factors identified.

Use of group a thawed plasma in emergency transfusions at a pediatric quaternary care center.

Balanced plasma/red blood cell transfusions have shown survival benefit in emergency scenarios. To improve plasma availability, we implemented 5-day group A thawed plasma at our pediatric hospital in February 2021. We maintain thawed group A plasma units (5-day shelf-life) ready for immediate issue in the blood bank (since February 2021) and trauma code room (since August 2022). Group A plasma (un-titered) is issued for patients with unknown blood type during emergencies. We retrospectively reviewed records and laboratory results of recipients to assess safety and identify possible adverse events related to incompatible plasma. Between February 2021 and December 2023, 173 emergency plasma requests occurred for 161 patients. Ninety-one occurred with massive transfusion protocol activations. Thirty-six patients (22.4%) were blood group B or AB, and 23 received incompatible plasma (age 0-21.3 years, weight 0.74-149.8 kg, incompatible plasma dose 4.0-428.4 mL/kg). These patients did not have any differences in survival outcomes or hospital lengths of stay (LOS) compared with compatible plasma recipients, mirroring the adult experience. None experienced adverse events related to group A plasma. No transfusion reactions were reported. No increase in wastage/outdate occurred upon thawed plasma implementation (2020 versus 2021 to 2023, 7.73% [133/1721] vs. 8.58% [497/5792], p = .284). We implemented 5-day group A thawed plasma. Units are rapidly available from the blood bank and trauma code room without increased wastage. We did not identify any transfusion-associated adverse events in pediatric recipients of incompatible group A plasma.